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Nomination Form
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Nominee Information
First Name
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Last Name
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Organization
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Address 1
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Address 2
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Phone Number
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Email
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Nominator Information
First Name
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Last Name
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Organization
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Address1
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Address 2
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City
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State
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Zip
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Phone Number
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Email
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Why should your nominee win the Likens Award?
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What impact has your nominee had on their credit union and/or the credit union industry?
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